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169 Informing the Policy, Practice, and Research Agenda for Emergency Medical Services Oversight
Research Forum Abstracts through July 31, 2015 and April 1, 2016 through July 31, 2016. These time periods were used to serve as a seasonally comparative group. Inclusion criteria were any opioid analgesic written for all patients during the study period. There were no exclusion criteria. Reasons for opioid prescriptions were inferred from the primary diagnosis in the chart. Demographic and baseline clinical characteristics were calculated as means with standard deviations (SD) for continuous variables and numbers with percentages for categorical variables. Differences in the primary outcome variable of the number of opioid analgesia prescriptions between the time periods of Pre-NYM EPCS and Post-NYM EPCS were compared with two-sample z-test for the difference between proportions. The analyses were performed for each primary diagnosis separately as wells as for the overall prescriptions. All statistical tests are two-sided and a P-value of <0.05 was considered to indicate statistical significance. All data analyses were performed using the SAS software, Version 9.3 (SAS Inc., Cary, NC, USA). Results: In the four months studied prior to NYM EPCS our ED saw 31,335 patients, and 1370 prescriptions were written for opioid analgesics. In the same fourmonth period following the NYM EPCS our ED saw 31,300 patients, and 642 opioid prescriptions were written. This was a significant decrease of 53% of prescribed opiates (P<.0001). Prescriptions were separated into 15 different categories based on the primary diagnoses (Figure 1). When compared, the number of prescriptions written for each diagnosis post NYM EPCS was fewer in each category. There was a notable statistically significant (P<0.001) decrease in prescriptions post-NYM EPCS for the following diagnoses arthralgia/myalgia, back pain, dental pain, soft tissue injury, abdominal pain, neuropathic pain and genital pain. Conclusions: There was a significant decline of prescribed opioids from our ED after the NYM EPCS went into effect. Many diagnoses such as back pain, dental pain and abdominal pain showed a statistically significant drop in patients receiving prescriptions for opioid analgesics post-NYM EPCS.
Methods: This project used a three-phase, convergent mixed-methods approach: (1) a systematic environmental scan of 4 databases for peer-reviewed literature and 10 Web sites of governmental and professional organizations for grey-literature; (2) a qualitative analysis of four focus groups of 5-13 participants and ten one-on-one interviews with EMS stakeholders representing diversity in performance, community-setting, geographic region, and professional roles; and (3) a quantitative descriptive data analysis of the Michigan EMS Information System (MI-EMSIS). These three sources of data were triangulated to develop a comprehensive understanding of best practices in EMS oversight and quality measurement. Results: Pre-existing literature and qualitative findings suggest that most quality measurement occurs at the EMS personnel level. The descriptive analysis of reported variables in MI-EMSIS showed patterns of missingness by software platforms used, oversight agencies, and other characteristics. Triangulated findings showed best practices in EMS oversight in the following categories: structure, leadership, relationships, resources, collaboration, and community specific needs. Conclusions: State EMS oversight entities can be deliberate in their structures and processes related to the five areas found. Doing so can support the standardization and coordination of care, develop quality improvement collaborations between hospitals and EMS agencies, and promote more high quality EMS delivery. Furthermore, the convergent mixed methods used in this project can support the development of more policy-relevant, actionable evidence in emergency and acute care research.
170
Opioid Prescribing Varies Markedly Between Pediatric and General Emergency Departments for Children, Adolescents, and Young Adults With and Without Fracture
Menchine M, Lam CN, Arora S/USC Keck School of Medicine, Los Angeles, CA
169
Informing the Policy, Practice, and Research Agenda for Emergency Medical Services Oversight
Abir M, Taymour R, Lowell M, Wahl K, Scott J/University of Michigan, Ann Arbor, MI; Michigan Department of Health and Human Services, Lansing, MI
Study Objectives: In a 2015 report the Institute of Medicine (IOM) noted a fragmented EMS system in the United States, an absence of system-wide coordination and planning, and a lack of federal, state, and local accountability regarding EMS care. The IOM recommended understanding what roles the federal government, states, and local communities play in the oversight and evaluation of EMS system performance and how they may work together to improve care. This project, funded by the Michigan Department of Health and Human Services (MDHHS), aims to understand these relationships between oversight and EMS stake-holders in the state of Michigan, and to begin filling the knowledge gap noted by the IOM.
S68 Annals of Emergency Medicine
Study Objectives: For children, adolescents and young adults, EDs are the most common source of prescription opioids. This is of concern as recent evidence demonstrates that exposure to ED opioids is associated with higher risk of long term use. Among adolescents in particular, getting a legitimate opioid prescription increases the odds of misuse by 30%. The misuse most often comes from using leftover opioids. Pediatric EDs are generally thought to provide the highest quality care for young persons. However, it is not known if or how opioid administration and prescribing differs between pediatric-specific EDs and ED treating both adult and pediatric patients (general) EDs. We examine whether opioid prescribing patterns vary for children, adolescents and young adults depending on whether they are treated in a pediatric ED vs. general ED. Methods: Data were analyzed from the 8 most recent years (2006-2014) of the National Hospital Ambulatory Medical Care Survey, a nationally representative survey of ED visits compiled by the Centers for Disease Control and Prevention. Multivariate logistic regressions adjusting for age, triage acuity and using appropriate survey weighting strategies were employed. The outcomes of interest were the proportion of children, adolescents and young adults (age <25) who 1) were administered an opioid in the ED or 2) were given an outpatient opioid prescription. The predictor variable of interest was ED type - general ED vs. a pediatric ED. Pediatric ED was defined as an ED in which the average age of the patient population treated was less than 18. We conducted a second analysis after restricting the sample to cases with discharge diagnosis of fracture. Results: Pediatric EDs accounted for 3.7% of total EDs and 8.9% of the children, adolescents and young adults treated. For the total population, the adjusted odds of being administered an opioid in the ED was similar for patients treated in a pediatric vs. general (OR¼ 0.92, 95% CI 0.65-1.31, p¼0.65). Patients with fracture diagnoses had statistically similar odds of received an opioid whether in a pediatric or general ED (OR 1.47, 95% CI 0.82-2.63, p¼0.19). However, patients seen in a pediatric ED are much less likely to receive an outpatient prescription for opioids (OR 0.39 95% CI 0.27-0.55, p<0.01) than similar patients treated in a general ED. This was true for the fracture subset as well (OR 0.36 95% CI 0.20-0.66, p<0.01). Conclusions: Though children, adolescents and young adults had similar odds of being administered opioids while in the ED, they had more than twice the odds of receiving an outpatient opioid prescription from a general ED compared with a pediatric ED. For fracture patients, this pattern persisted. The question of which
Volume 70, no. 4s : October 2017
Methods: This project used a three-phase, convergent mixed-methods approach: (1) a systematic environmental scan of 4 databases for peer-reviewed literature and 10 Web sites of governmental and professional organizations for grey-literature; (2) a qualitative analysis of four focus groups of 5-13 participants and ten one-on-one interviews with EMS stakeholders representing diversity in performance, community-setting, geographic region, and professional roles; and (3) a quantitative descriptive data analysis of the Michigan EMS Information System (MI-EMSIS). These three sources of data were triangulated to develop a comprehensive understanding of best practices in EMS oversight and quality measurement. Results: Pre-existing literature and qualitative findings suggest that most quality measurement occurs at the EMS personnel level. The descriptive analysis of reported variables in MI-EMSIS showed patterns of missingness by software platforms used, oversight agencies, and other characteristics. Triangulated findings showed best practices in EMS oversight in the following categories: structure, leadership, relationships, resources, collaboration, and community specific needs. Conclusions: State EMS oversight entities can be deliberate in their structures and processes related to the five areas found. Doing so can support the standardization and coordination of care, develop quality improvement collaborations between hospitals and EMS agencies, and promote more high quality EMS delivery. Furthermore, the convergent mixed methods used in this project can support the development of more policy-relevant, actionable evidence in emergency and acute care research.
170
Opioid Prescribing Varies Markedly Between Pediatric and General Emergency Departments for Children, Adolescents, and Young Adults With and Without Fracture
Menchine M, Lam CN, Arora S/USC Keck School of Medicine, Los Angeles, CA
169
Informing the Policy, Practice, and Research Agenda for Emergency Medical Services Oversight
Abir M, Taymour R, Lowell M, Wahl K, Scott J/University of Michigan, Ann Arbor, MI; Michigan Department of Health and Human Services, Lansing, MI
Study Objectives: In a 2015 report the Institute of Medicine (IOM) noted a fragmented EMS system in the United States, an absence of system-wide coordination and planning, and a lack of federal, state, and local accountability regarding EMS care. The IOM recommended understanding what roles the federal government, states, and local communities play in the oversight and evaluation of EMS system performance and how they may work together to improve care. This project, funded by the Michigan Department of Health and Human Services (MDHHS), aims to understand these relationships between oversight and EMS stake-holders in the state of Michigan, and to begin filling the knowledge gap noted by the IOM.
S68 Annals of Emergency Medicine
Study Objectives: For children, adolescents and young adults, EDs are the most common source of prescription opioids. This is of concern as recent evidence demonstrates that exposure to ED opioids is associated with higher risk of long term use. Among adolescents in particular, getting a legitimate opioid prescription increases the odds of misuse by 30%. The misuse most often comes from using leftover opioids. Pediatric EDs are generally thought to provide the highest quality care for young persons. However, it is not known if or how opioid administration and prescribing differs between pediatric-specific EDs and ED treating both adult and pediatric patients (general) EDs. We examine whether opioid prescribing patterns vary for children, adolescents and young adults depending on whether they are treated in a pediatric ED vs. general ED. Methods: Data were analyzed from the 8 most recent years (2006-2014) of the National Hospital Ambulatory Medical Care Survey, a nationally representative survey of ED visits compiled by the Centers for Disease Control and Prevention. Multivariate logistic regressions adjusting for age, triage acuity and using appropriate survey weighting strategies were employed. The outcomes of interest were the proportion of children, adolescents and young adults (age <25) who 1) were administered an opioid in the ED or 2) were given an outpatient opioid prescription. The predictor variable of interest was ED type - general ED vs. a pediatric ED. Pediatric ED was defined as an ED in which the average age of the patient population treated was less than 18. We conducted a second analysis after restricting the sample to cases with discharge diagnosis of fracture. Results: Pediatric EDs accounted for 3.7% of total EDs and 8.9% of the children, adolescents and young adults treated. For the total population, the adjusted odds of being administered an opioid in the ED was similar for patients treated in a pediatric vs. general (OR¼ 0.92, 95% CI 0.65-1.31, p¼0.65). Patients with fracture diagnoses had statistically similar odds of received an opioid whether in a pediatric or general ED (OR 1.47, 95% CI 0.82-2.63, p¼0.19). However, patients seen in a pediatric ED are much less likely to receive an outpatient prescription for opioids (OR 0.39 95% CI 0.27-0.55, p<0.01) than similar patients treated in a general ED. This was true for the fracture subset as well (OR 0.36 95% CI 0.20-0.66, p<0.01). Conclusions: Though children, adolescents and young adults had similar odds of being administered opioids while in the ED, they had more than twice the odds of receiving an outpatient opioid prescription from a general ED compared with a pediatric ED. For fracture patients, this pattern persisted. The question of which
Volume 70, no. 4s : October 2017